The man behind Britain’s unprecedented doctors’ strike

LONDON — The man with a bull’s eye trained on him by the U.K.’s striking doctors has been in this position before.

Before becoming Britain’s health secretary, Jeremy Hunt imposed sweeping budget cuts as secretary of state for culture, media and sport and faced pressure to resign over allegations he was too close to Rupert Murdoch’s family during a takeover bid. When he was promoted to health, the Guardian described him as the “least mourned secretary of state in the culture department’s history.”

Now he is locked in an even more consequential fight with doctors, which has resulted in unprecedented strikes — affecting emergency care for the first time ever — as he tries to write new National Health Service contracts for about one third of the British medical workforce.

Hunt refuses to return to the negotiating table and wants to force adoption of the contract. Doctors, in response, launched a legal action. They are considering further walk-outs and mass resignations. By taking on the health service, Hunt has pitted himself against one of Britain’s most cherished institutions. The most recent polling puts support for doctors comfortably above 50 percent.

Once considered a safe pairs of hands, Hunt’s latest battle comes at a terrible time for Prime Minister David Cameron as he tries to focus the public’s attention on Europe.

When asked if he had any dark nights, Hunt told the BBC’s flagship morning news program last week: “This is likely to be my last big job in politics.”

To some observers, this was an unambiguous — and surprising — sign he has had enough. To his ministerial colleagues, Hunt’s message was clear: Please don’t sack me.

“The prime minister would be inclined to put someone else in there,” one Conservative minister told POLITICO. “Jeremy is a proud man, he won’t want to leave having ‘lost.’ He was saying, ‘I don’t want to go – give me a few more years.’”

Others who have worked closely with him are certain Hunt, who declined repeated requests for an interview, still has his sights set on being next Tory leader.

“I think he’s getting desperate now. That’s the latest bit of spin from one of the biggest spinners in the government,” said a Tory MP who spoke on condition of anonymity.

But are Hunt’s eyebrow-raising, very public battles the product of his own manhandling of situations? Or is he the victim of Cameron’s promises and Chancellor George Osborne’s budget cuts?

The man from the shires

On paper, Hunt appears to be textbook conservative stock: The son of a Royal Navy admiral, head boy at London’s Charterhouse School, and a first-class degree in philosophy, politics and economics from Oxford University. Raised in the Surrey village of Shere — one of the prettiest, most postcard-perfect in the home counties that surround London — Hunt’s a self-made millionaire from his company Hotcourses.

During his time at Oxford he was president of the Conservative Association and a contemporary of Cameron, Justice Secretary Michael Gove and Mayor of London Boris Johnson.

He can come off as an affable, pragmatic man. Hunt’s “a Tory henchman of the Cameron ilk and set. A slightly blinking robotic demeanor … but charming,” said Neil Midgley, media commentator for the Daily Telegraph, who thinks the health secretary is “much maligned and … much more sensitive under the surface.”

As culture secretary from 2010 to 2012, Hunt demonstrated his willingness to sully his hands for his party.

“Jeremy never seemed to fail when asked to do dirty work required by the grand plans of his masters [Cameron and Osborne],” said Midgley.

After arriving at the Department for Culture, Media and Sport, Hunt implemented sweeping 30 percent budget cuts almost immediately. He axed the U.K. Film Council and Museums, Libraries, Archives Council and directed the chair of Arts Council England to step down.

And it was all done with a smile after wooing the arts community.

“He said, ‘I didn’t become culture secretary to cut arts budgets,’ but that’s exactly what he’s done,” Nicholas Kent, who was director of London’s Tricycle Theatre at the time, told the BBC in 2012.

Hunt is a “careerist politician” according to Kent, while one of the minister’s own civil servants told the broadcaster: “Beneath the smooth smarmy manner he had callous crude insensitivity of David Brent – Ricky Gervais’s character in The Office [a satirical TV sitcom].”

It would be kind to say that not everyone in Parliament is a fan either, particularly those who have worked closely with him.

Andy Burnham, Labour’s home affairs spokesman, knows Hunt well having shadowed him for almost three years in health before last year’s general election. Before that, when Burnham was culture secretary under former Prime Minister Gordon Brown, Hunt was his opposite number for the Tories.

Burnham, who is widely seen in Westminster as mild-mannered and collegiate, “hates” Hunt and describes him in private as the “worst kind of self-serving politician,” said a source close to Labour frontbencher.

“He cannot stand him. It’s personal. He just detests him. … In the last Parliament, Jeremy turned problems in the NHS on their watch into personal attacks on Andy. It was clever, politically, and it worked to a certain extent.”

Lightning rod

If Hunt faced a challenge having to tighten budgets in the culture department, it was nothing compared to the high stakes of health.

Things started reasonably well. Although it’s traditionally one of the Labour Party’s strongest suits, health didn’t cause Cameron trouble in the last election.

“Right up until the doctors’ strike, he was seen as a safe pair of hands,” said a Tory minister who asked not to be named. “Remember he got us to the election and it wasn’t an issue, despite the winter crisis [inability of hospitals to cope with higher number of patients falling ill].”

Much of the hostility towards Hunt is because he’s been given an impossible task with the doctors, said Liberal Democrat MP Norman Lamb, a former health minister in his department under the previous coalition government.

“I think ultimately the root cause of this dispute [with doctors] is not the narrow confines of this contractual argument, but the finances of the NHS. It’s impossible — the system is under immense strain,” said Lamb, adding Hunt has become “the lightning rod” in this fight.

NHS England said the health service faces a £30 billion shortfall by 2020-21 at current rates of increasing demand. The government has committed £10 billion and has tasked hospitals and care providers to find more than £20 billion in efficiency savings.

At the same time, there is political pressure from Downing Street to fulfill commitments to improve and widen access to care.

“The idea of the seven-day NHS is a big idea in the manifesto and Cameron doesn’t like shifting back on his manifesto,” said Mike Smithson, political commentator and editor of the blog politicalbetting.com.

Before the 2015 election the Conservative party promised that by 2020 everyone in the U.K. would be able to see their family doctor or receive hospital treatment seven days a week, a pledge contested by doctors who argue a seven-day service already exists for acute care and extending this to more routine treatment would require significant additional resources.

Meanwhile, Hunt’s new contract hasn’t been shown to improve the service within budget, according to the Tory MP who asked not to be named “so it’s very difficult to defend.”

“If you don’t understand the policy you are trying to implement it makes it very difficult to dress that up well, no matter how well you do it,” the MP said.

Political miscalculations

Colleagues don’t question Hunt’s work ethic. “He does get his hands dirty, Jeremy. He does these undercover visits to hospitals,” the Tory minister said. “He was doing quite a few of these visits without any publicity at all.”

However, the recent battle with doctors suggests a lack of political nous, creating a situation in which Cameron’s government is pitted against the NHS. The minister said he should have left it to individual NHS trusts or Simon Stevens, the NHS chief executive, to fight it out with doctors.

“What are we doing letting the dispute be characterized in this way?” the minister said. “Does he have a sure political hand? A sureness of touch? He’s not quite as good as we would’ve hoped.”

Such is the level of toxicity, doctors even accuse Hunt of endangering patient safety with his rhetoric.

Matt Varrier, a hematology specialist at Guy’s and St Thomas’ Hospital in London, said Hunt’s “spin” about higher mortality on weekends has caused the “Hunt effect” — patients avoiding hospital and waiting until Monday to go to the emergency department.

By this time they are very sick and it’s caused more deaths, Varrier said.

Hunt for prime minister

Back in 2010 political journalist Matthew D’Ancona, wrote in GQ magazine that Hunt is “a man so ambitious he squeaks when he walks.”

Getting embroiled in an industrial dispute might not seem like the best position from which to launch a leadership bid but some who know him don’t think this will deter him from pursuing his political career to the highest office.

“I think he has always had sights on [leadership], but I don’t think he has ever had any following in the party. No one really knows what he believes or what he stands for as a person,” said the Tory MP, adding Hunt’s main focus is on “making him look good rather than the policy objective.”

For some Tories, a man who can win a fight against the unions might be a man worth backing as leader.

“Nothing endears a senior Tory politician to the party more than picking a fight with a trade union and winning it, as Margaret Thatcher discovered,” Toby Young wrote in The Telegraph last week.

But even for a man well-used to a scrap, Hunt has a monumental battle on his hands. Doctors show no sign of backing down and reached record turnout for the full walkout.

And with Cameron and Osborne focused on keeping Britain in the European Union, for the moment this fight will be Hunt’s and Hunt’s alone.

Mary Hawking

Trusts have been working on rotas under the new, imposed junior contract – and finding that they need extra doctors to avoid rota gaps: the uptake of training posts has fallen – for the first time – below 50% of newly qualified doctors completing foundation years 1 & 2, and many existing posts remain unfilled.
Training osts – for all health staff – are funded mainly by Health Education England: their budget has been cut, and it is not clear that the removal of nursing bursaries will be sufficient to fill the gap: it certainly would not be sufficient to fund the number of additional doctor training positions needed to fill the rotas – even if a decision was made to fund medical training at the expense of nursing and other healthcare posts.
In addition, the supply of locums has dried up since the introduction of a cap on agency fees – and the requirement that junior doctors should offer any available sessions to their employing Trust will agravate the situation.

Jeremy Hunt – or his advisors – do not appear to have done any modeling of the effects of the new junior contract he is so keen to impose: and his power to impose anything was removed by the Health & Social Care Act: or did the Act just remove any responsibility for his actions or the consequences of them?
Not a good record for any politician with ambitions to lead his party – but I suppose marginally better than Boris Johnson!